Pharyngo-cutaneous fistula: An old problem revisited

Abstract

Conclusion: Pharyngo-cutaneous fistula is the most common complication after total laryngectomy (TL), with many factors linked to its emergence. However, it has rarely been associated with the type of pharyngeal suture. We conclude that the technique of surgical closure of the pharynx and care in the tightness of the suture seem to be fundamental factors for pharyngo-cutaneous fistula development. Objective: The aim of present work was to determine whether the type of pharyngeal suture can be considered as a major risk factor for developing a pharyngo-cutaneous fistula following TL. Methods: We carried out a series of 157 consecutive TLs. In the first 90 procedures, we performed a pharyngeal closure technique with T-shaped interrupted stitches reinforced with constrictors. In the other 67 cases, a doubled continuous suture technique with reinforcement with the cutaneous flap was developed. Results: In all, 25.5% of the cases sutured with the interrupted stitches developed a fistula while only 2.9% of the patients that underwent continuous suture developed a fistula.

Keywords::

• Total laryngectomy
• pharyngostome
• pharyngeal suture

Acknowledgments

The authors are grateful to Dr Adam J. Donne (Department of Otolaryngology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK) for his useful scientific and style revision of the present paper and to Ms Cristina Fernández (Service of Preventive Medicine of the Hospital Clínico San Carlos of Madrid, Spain) for the statistical work carried out.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.